{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:49:33Z","timestamp":1787496573738,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,5,7]],"date-time":"2015-05-07T00:00:00Z","timestamp":1430956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,7]]},"abstract":"\n Background<\/jats:title>\n The role of episiotomy in vacuum deliveries is controversial.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To perform a meta\u2010analysis of the literature examining this subject.<\/jats:p>\n <\/jats:sec>\n \n Search strategy<\/jats:title>\n The search was conducted in four databases.<\/jats:p>\n <\/jats:sec>\n \n Selection criteria<\/jats:title>\n Two investigators independently selected original research examining the effects of episiotomy on any neonatal and maternal outcomes during vacuum delivery.<\/jats:p>\n <\/jats:sec>\n \n Data collection and analysis<\/jats:title>\n \n The effect estimates were presented as odds ratios (\n OR<\/jats:styled-content>\n s) with 95% confidence intervals (95%\n CI<\/jats:styled-content>\n s).\n <\/jats:p>\n <\/jats:sec>\n \n Main results<\/jats:title>\n \n Fifteen articles were included, encompassing a total of 350\u00a0764 vacuum deliveries. A non\u2010significant relationship was shown between mediolateral episiotomy and obstetric anal sphincter injuries (\n OASIS<\/jats:styled-content>\n ) in nulliparous women (\n OR<\/jats:styled-content>\n 0.68, 95%\n CI<\/jats:styled-content>\n 0.43\u20131.07; six studies), whereas an increased risk was demonstrated in parous women (\n OR<\/jats:styled-content>\n 1.27, 95%\n CI<\/jats:styled-content>\n 1.05\u20131.53; two reports). A higher risk of\n OASIS<\/jats:styled-content>\n with median episiotomy use was shown in nulliparous (\n OR<\/jats:styled-content>\n 5.11, 95%\u00a0\n CI<\/jats:styled-content>\n 3.23\u20138.08; two studies) as well as in parous (\n OR<\/jats:styled-content>\n 89.4, 95%\u00a0\n CI<\/jats:styled-content>\n 11.8\u2013677.1; one study) women. Lateral episiotomy was related to lower\n OASIS<\/jats:styled-content>\n risk in nullipara (\n OR<\/jats:styled-content>\n \u00a00.59, 95%\u00a0\n CI<\/jats:styled-content>\n 0.49\u20130.70; single paper). Mediolateral episiotomy was linked to increased rates of postpartum haemorrhage (\n OR<\/jats:styled-content>\n \u00a01.82, 95%\u00a0\n CI<\/jats:styled-content>\n 1.16\u20132.86) and analgesia use (\n OR<\/jats:styled-content>\n \u00a02.10, 95%\u00a0\n CI<\/jats:styled-content>\n 1.39\u20133.17; two reports). Overall, the quality of evidence was rated as low to very low.\n <\/jats:p>\n <\/jats:sec>\n \n Author's conclusions<\/jats:title>\n \n Mediolateral and median episiotomy in parous woman may increase the rate of\n OASIS<\/jats:styled-content>\n at vacuum delivery, whereas lateral episiotomy in nulliparous women could be associated with a decreased risk of\n OASIS<\/jats:styled-content>\n . The suboptimal quality of the available evidence necessitates high\u2010quality well\u2010designed randomised trials.\n <\/jats:p>\n <\/jats:sec>\n \n Tweetable abstract<\/jats:title>\n Episiotomy in vacuum delivery does not appear to be of benefit, and might even increase maternal morbidity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.13439","type":"journal-article","created":{"date-parts":[[2015,5,7]],"date-time":"2015-05-07T01:51:08Z","timestamp":1430963468000},"page":"1073-1081","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"122","author":[{"given":"L","family":"Sagi\u2010Dain","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Carmel Medical Centre Haifa Israel"},{"name":"Genetics Institute HaEmek Medical Centre Afula Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Sagi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Bnai Zion Medical Centre Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,5,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01304.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-36"},{"key":"e_1_2_6_4_1","first-page":"5","article-title":"Vacuum\u2010assisted vaginal delivery","volume":"2","author":"Ali UA","year":"2009","journal-title":"Rev Obstet Gynecol"},{"key":"e_1_2_6_5_1","first-page":"3","volume-title":"Advanced Life Support in Obstetrics (ALSO) Provider Syllabus","author":"Hook CD","year":"2003"},{"key":"e_1_2_6_6_1","first-page":"69","article-title":"Operative vaginal delivery. 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